title: Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers.
abstract: BACKGROUND
  Surgical simulation models are often limited by their lack of fidelity, which hinders their essential purpose, making a better surgeon. Fresh cadaveric tissue is a superior model of simulation owing to its approximation of live tissue. One major unresolved difference between dead and live tissue is perfusion. Here, we propose a means of enhancing the fidelity of cadaveric simulation through the development of a perfused cadaveric model whereby simulation is further able to approach life-like surgery and teach one of the more technically demanding skills of plastic surgery: microsurgery.
  
  
  METHODS
  Fresh tissue human cadavers were procured according to university protocol. Perfusion was performed via cannulation of large vessels, and arterial and venous pressure was maintained by centrifugal circulation. Skin perfusion was evaluated with incisions in the perfused regions and was evaluated using indocyanine green angiography. Surgical simulations were selected to broadly evaluate applicability to plastic surgical education.
  
  
  RESULTS
  Surgical simulation of 38 procedures ranging in complexity from skin excisions to microsurgical cases was performed with high priority given to the accurate simulation of clinical procedures. Flap dissections included perforator flaps, muscle flaps, and fasciocutaneous flaps. Effective perfusion was noted with ICG angiography and notable bleeding vessels. Microsurgical flap transfer was successfully performed.
  
  
  CONCLUSIONS
  We report the establishment of a high fidelity surgical simulation using a perfused fresh tissue model in a realistic environment akin to the operating room. We anticipate utilization of this model prior to entering the operating room will enhance surgical ability and offer a valuable resource in plastic surgical education.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. Electronic address: Joseph.Carey@med.usc.edu.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Carey
authors.affiliation: Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rommer
authors.affiliation: Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Clifford
authors.initials: C
authors.lastname: Sheckter
authors.affiliation: Surgical Skills Simulation & Education Center, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Minneti
authors.affiliation: Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.affiliation: Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Alex K
authors.initials: AK
authors.lastname: Wong
authors.affiliation: Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Warren
authors.initials: W
authors.lastname: Garner
authors.affiliation: Division of Plastic & Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Urata
mesh_terms: D000792:Angiography; D002102:Cadaver; D004396:Coloring Agents; D004503:Education, Medical, Graduate / Q000379:methods; D006801:Humans; D007208:Indocyanine Green; D008866:Microsurgery / Q000193:education*; D055806:Microvessels / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000193:education; D013518:Surgery, Plastic / Q000193:education*; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures / Q000193:education*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Fresh tissue dissection; Microsurgery; Resident education; Resident work hour restrictions; Surgical education; Surgical simulation